Michael Coburn, MD, FACS, presented “Advanced Scrotology – Surgical Challenges in Scrotal Surgery” during the 29th Annual Innovations in Urologic Practice on September 19th, 2025, in Santa Fe, New Mexico.
How to cite: Coburn, Michael. “Advanced Scrotology – Surgical Challenges in Scrotal Surgery.” September 19th, 2025. Accessed Dec 2025. https://grandroundsinurology.com/advanced-scrotology-surgical-challenges-in-scrotal-surgery/
Advanced Scrotology – Surgical Challenges in Scrotal Surgery – Summary
Michael Coburn, MD, FACS, Professor and Chair of Urology, Baylor College of Medicine, Houston, Texas, discusses challenging surgical scenarios involving the scrotal wall and contents, including trauma, necrotizing infections, and chronic inflammatory diseases. He highlights that many cases, while complex, are manageable in community practice when guided by core reconstructive and trauma principles.
In testicular trauma, Dr. Coburn emphasizes the importance of timely exploration and repair of testicular rupture when viable parenchyma remains. Ultrasound reliably detects rupture through disruption of the tunica albuginea. He presents techniques for complex salvage, including tissue transfer using bipedicled tunica vaginalis flaps for partial capsule loss, allowing for viable testicular preservation.
Dr. Coburn transitions to infectious and inflammatory conditions, focusing on Fournier’s gangrene. He emphasizes the importance of early recognition, aggressive debridement, broad-spectrum antimicrobial therapy, and the use of vacuum-assisted closure (VAC) systems to reduce operative frequency and promote granulation.
He also reviews management of genital lymphedema and hidradenitis suppurativa. Surgical excision remains the cornerstone of treatment for advanced disease, with vessel-sealing technology preferred over standard electrocautery to limit postoperative lymphatic leakage. Collaboration with plastic surgery facilitates flap or graft reconstruction, improving both functional and cosmetic outcomes. Dr. Coburn concludes that multidisciplinary care, careful staging, and use of contemporary wound management tools are key to optimizing outcomes in severe scrotal pathology.
About The 29th Annual Innovations in Urologic Practice:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient. Dr. Coburn presented this talk at the 2025 conference.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Michael Coburn, MD, FACS, is Professor and Russel and Mary Hugh Scott Chair in Urology at Baylor College of Medicine in Houston, Texas. His clinical and research interests focus on urologic trauma, genital and urethral reconstructive surgery, and sexual and reproductive dysfunction.
